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The patient ran about during the plum rain season of late summer. The inner ankle felt heavy and drooping with macules appearing, lower jiao pain started, followed by tendon spasms extending to the popliteal fossa and left arm.

The *Classic* states: "Those injured by dampness, the lower part receives it first." This is because the flow of the extraordinary vessels in the lower jiao is obstructed, causing heaviness in the inner ankle; the Yin Wei vessel is affected, and over time, it must transform into heat that scorches blood, stirring internal wind which enters internally to store in the Liver and Gallbladder. This is what is meant by the Shaoyang channel running along the side of the body. The pulse diagnosis reveals a slow right pulse and a solid left pulse. Damp-heat is mixed within the blood collaterals, making it very difficult to search out and expel. This condition originated from damp-bi syndrome, neglected treatment, and prolonged into flaccidity and chronic illness. A three-year root disease cannot be attacked hastily and violently; for now, we tentatively advance methods to first unblock the Ying (Nutrient) collaterals, incorporating treatment of the extraordinary vessels. Ancient sages treated flaccidity and bi by focusing solely on the Yangming channel; only by unblocking can evil be extracted.

Deer Antler Frost, Raw Atractylodis Macrocephalae Rhizoma, Cinnamon Twig, Poria, Chuanxiong Rhizoma, Angelica Sinensis Tail, Tribulus Fruit, Yellow Chrysanthemum Flower.

In the meridians and collaterals of the four limbs, when the weather is cold and gloomy, pain and spasms occur. When carbuncles, sores, or ulcers suppurate, the disease lies dormant; after the ulcer heals, the disease returns. Moreover, epistaxis or nasal congestion occurs frequently. The *Classic* holds that Wind, Cold, and Dampness combine to form Bi. However, over years and months, external evils linger, injuring Qi and Blood, transforming into failed stasis and congealed phlegm, mixing within the meridians. If treatment is lost, Qi declines with age, leading to disability and chronic illness.

Angelica Sinensis Tail, Earthworm, Pangolin Scales, White Mustard Seed, Chuanxiong Rhizoma, Tribulus Fruit, made into pills with half wine and half water.

Historically, treating Bi syndrome focuses on the miscellany of Wind, Cold, and Dampness. The difference in illness arises from external Summerheat-Dampness and internal Damp-Heat retained from food and drink. External evils attach to meridians; internal evils attach to fu organ collaterals. Thus, after acrid-warm sweating, heat and pain do not decrease. I used urgent clearing of the Yangming channel, resulting in slight improvement. Recurrence during illness is due to inhaling Summerheat through mouth and nose. Post-illness requires bland diet to refresh Yangming Qi, allowing Clear Yang to flow continuously, relaxing limb joints and collaterals, uprooting flaccidity and bi. Warm tonification seeking quick effects is unsuitable for robust constitutions.

Ginseng, Poria, Pinellia Tuber, Tangerine Peel, Raw Atractylodis Macrocephalae Rhizoma, Immature Bitter Orange, Coptis Rhizome, Alisma Rhizome, Bamboo Sap, Ginger Juice, made into pills.

For rheumatic swelling and bi, the world believes guest evils should be dispersed, yet treatment worsens the condition, failing to understand the initial cause was fatigue and internal injury. Where evil gathers, Qi must be deficient. Ginseng and Atractylodes tonify Qi, assisted by wind-dispelling herbs; strong Qi pushes out evil, stopping pain. The patient claims hands and feet feel like they have fallen off, indicating Yang deficiency failing to reach the extremities. These are errors in treatment, wasting Ginseng.

Ginseng, Raw Atractylodis Macrocephalae Rhizoma, Astragalus Root, Angelica Sinensis Root Body, Cinnamon Bark, Honey-fried Licorice Root, Roasted Ginger, Southern Jujube.

Rheumatic guest evils remain in meridians, moving up and down the four limbs, causing wandering pain, touching various places without staying fixed, anciently called Zhou Bi. After decades, simple decoctions and powders cannot work. New evils should be dispersed urgently; old evils should be attacked slowly.

Dung Beetle, Whole Scorpion, Earthworm, Pangolin Scales, Beehive, Aconite Root, Musk, Frankincense, made into pills with black soybeans boiled in pure wine.

Left pulse is wiry and large, face red, much phlegm, bowel movement unsatisfactory. This is labor and anger stirring Liver, preventing Yang Qi from interacting with Yin. Yang Wei and Yang Qiao vessels lack blood nourishment, internal wind scorches tendons, dorsal foot bi pain, worse at night when Jueyin is prosperous. Disease is in the collaterals.

Dendrobium, Silkworm Frass, Stephania Tetrandra, Phellodendron Bark, Pinellia Tuber, Dioscorea Hypoglauca Rhizome, Betel Nut Juice.

Winter warmth prevents True Qi from hiding; evil hides due to internal deficiency. At Jingzhe solar term, Spring Yang moves internally, triggering latent qi. Initial Wind-Cold transforms into Heat; sitting up late at night leaks Yang Qi. Physicians stick to Wind-Cold-Damp forming Bi, ignoring disease transformation over time. Using Notopterygium, Saposhnikovia, and Kudzu Root again leaks Yang, worsening the condition. Propose Zhang Zhongjing's Mufangji Decoction method.

Stephania Tetrandra, Gypsum Fibrosum, Cinnamon Twig, Turmeric Rhizome, Apricot Seed, Mulberry Bark.

Yang constrained by fatigue manifests as internal heat and wind. The *Inner Classic* says heat causes wind to dissipate, requiring Sweet-Cold herbs. Previous discussion noted wine drinkers dislike sweet taste, and with much phlegm and little appetite, sweet-greasy cloying herbs are contraindicated. Clearing Shaoyang Gallbladder heat works as wine enters Liver/Gallbladder first. Wine dampness affects intestines/stomach; regulating intestines unblocks stomach. Stomach-intestine Qi mechanism flows, appetite increases, but slippery discharge is greasy. Now Qi is hot, rising at noon, meridian bi pain is less than usual. Mainly harmonize Yang with Sweet-Cold, promote meridians, assist regulation.

Young Mulberry Twig, Antelope Horn, Asparagus Fern Tuber, Lycium Fruit, Tribulus Fruit, Moutan Cortex, Poria, Huoshan Dendrobium, boiled into paste.

Acrid-aromatic penetrating herbs unblock Qi-level dampness in congested meridians, having disease-resolving ability but no tonifying benefit. Generally, medicines spread from the Middle Palace to all meridians. Middle Jiao is the root of Ying Qi; if Ying Qi lacks nourishment, rotation becomes dull. Attacking disease relies on medicinal bias; changing morning and evening is not the way to completely remove disease. Additionally, take a nourishing prescription at night.

Ginseng, Poria, Cinnamon Twig Wood, Honey-fried Licorice Root, Angelica Sinensis, Stir-fried White Peony Root, Southern Jujube.

*Rites of Zhou* collects toxic drugs for medical use. Because stubborn chronic illnesses attach to the shell/body, not necessarily Zang-Fu deficiency, toxic drugs are needed to attack and extract, preventing evil from lingering in Qi and Blood. Once effective, the *Classic* says: treat with great toxicity, remove five-tenths. Now one should only care for the body, avoid emotional labor, achieving full merit. Fools say medicine removes roots, not knowing Heaven and Earth Qi has victory and return, similarly humans. Grain drinks nourish life, but medicinal bias cannot be taken long-term. Observe alchemists taking metal/stone elixirs, dying from carbuncles frequently.

Polygonum Multiflorum, Black Sesame Seed, Mulberry Twig, Cinnamon Twig Decoction, made into pills.

Using Liver-blood tonifying and wind-extinguishing formula, right fingers still numb, walking causes stiffness, Xu-Hai hours (7-11 PM) bring heart heat and vexation. Previous methods ineffective; Goji and Angelica are acrid-warm, Yang moves so wind moves. Propose removing acrid using salty. If suspecting residual malaria pathogen from travel causing meridian stagnation, combine with unblocking, slow attack is also good.

Prepared Rehmannia Root, Tortoise Shell Glue, Donkey-hide Gelatin, Autumn Stone, Asparagus Fern Tuber, Ophiopogon Tuber, Schisandra Berry, Spirit of Poria, honey pills taken in morning.

Peach Kernel, Pangolin Scales, Earthworm, Chuanxiong Rhizoma, Angelica Sinensis Tail, Moutan Cortex, Safflower, Astragalus Complanatus Seed, Cyperus Rhizome Juice, pills taken at night.

Back pain worsens with massage, spitting saliva foam, shortness of breath, abdominal fullness, lower abdomen hard, urinary retention, spontaneous loose stools, lower body numbness, immobility, anorexia, insomnia, sweating with vexation. Pathogenesis is complex, no standard method. Thinking cold turbidity occupies, Yang deficiency fails to move, presenting as obstruction. Two Qi are discordant, cannot ignore. Citing Zhang Zhongjing's Shaoyin example, urgently advancing Yang unblocking is key. Propose Baotong Decoction plus Human Urine and Pig Bile.

Scallion White (without roots), Mild Dried Ginger, Raw and Fried Aconite Root, Human Urine and Pig Bile mixed for administration.

Pulse wiry, right large. Wiry indicates fluid retention; large indicates Stomach Yang deficiency. Due to mental strain and accumulation of fatigue, Yang deficiency leads to lack of hunger and appetite. Forced food intake is not transported. Anger combined with restless sleep, waking more than sleeping, inner vexation, sudden abdominal borborygmus and Qi rumbling, four limbs tendons and joints weak and powerless. Onset had morning cold spasms, slight coldness on dorsal foot. Following pulse/symptoms for years, Yang deficiency is root, while phlegm-fluid and Qi rebellion gather due to deficiency. Deficiency generates cold, excess generates heat. Restless sleep/appetite nearly half a year, entering fourth Qi period. Late Summer damp earth insults Spleen/Stomach, worrying about muscle swelling and abdominal distension. Thus whole body binding tendons and benefiting joints relies on Yangming Stomach Meridian. Reviewing medical prescriptions, Qi/Blood mixed, Cold/Heat intermixed, not focusing on Yin/Yang bias, regulation should not respond. Propose tonifying/regulating Stomach Yang as main, soothing Liver as auxiliary. Qi spreads, Yang revives, why worry about turbid phlegm obscuring? Use Fuling Yin reducing Atractylodes, combining Xue's Star and Aconitum Liujunzi intent.

Ginseng, Poria, Cyperus Rhizome, Perilla Stem, Typhonium Rhizome, Pinellia Tuber, Ginger Juice, Tangerine Peel.

Whole body pulling pain, head cannot turn, hand cannot grasp, foot cannot move, both pulses floating and deficient. Floating is Wind image, but internal deficiency also presents floating and weak pulse. Combining pulse and symptoms, this is fatigue injuring Middle, Yangming failing. Yangming is the Sea of Five Zang and Six Fu, binding sinews and bones and benefiting joints. Yangming failure means Qi/Blood do not nourish, twelve meridians receive nothing and do not function. Wei (Defensive) empty, Ying (Nutrient) flow unfavorable, struggling causing pain, naturally so. Method should greatly tonify Yangming Qi and Blood, not treating same as Wind-Cold-Damp Bi.

Ginseng, Astragalus Root, Angelica Sinensis Root Body, Licorice Root, Cinnamon Twig Wood, Gentian Root, Atractylodis Macrocephalae Rhizoma.

Late Summer damp bi, meridian flow Qi sluggish, plus lower origin collaterals already deficient, flaccidity unable to walk, spine often sore. Bowels either constipated or loose, all belong to Liver/Kidney extraordinary vessel disease. Must assist unblocking collaterals as correct treatment. If merely static tonification, later summer will surely generate damp disturbance, must plan ahead.

Cistanche Deserticola, Small Fennel Seed, Morinda Officinalis Root, Angelica Sinensis Root Body, Polygala Tuber, Deer Antler Frost, Mulberry Fruit, Raw Atractylodis Rhizoma, Poria, Prepared Rehmannia Root, Cystopteris Filix-mas, boiled into paste and made into pills.

Pulse faint and choppy. Faint is Yang Qi deficiency, choppy is Yin Blood injury. Last winter lower limbs alone were cold, walking weak. High age lacks storage function. Entering summer, body movement adds panting, skin/muscle paralysis like insects crawling. This is True Yang losing hibernation, Stomach Yang losing protection, vitality scarce. Not suitable for attacking disease drugs. Mr. Yu Jiayan said seal and fix greatly, do not let True Yang leak out and collapse suddenly, this applies here. Record Yan's Three Causes Formula.

Ginseng, Atractylodis Rhizoma, Aconite Root.

According to description, autumn external evil changed to malaria, lasting 100 days to heal. Autumn malaria is Summerheat-Damp-Heat hidden internally in summer, triggered by new coolness externally. Vulgar physicians only know Chai Ge Jie Ji, thinking Summerheat-Damp injures Qi level. Medicine moves Blood, Blood injury causes spasm/bi. Heat tendons relax, cold tendons contract, eventually forming refractory flaccidity-bi.

Angelica Sinensis Root Body, Taxillus Chinensis, Tiger Bone (Synthetic/Substitute implied), Lycium Fruit, Chuanxiong Rhizoma, Astragalus Complanatus Tribulus.

Blood injury suddenly adds fright, Qi depression heat rises wind spins, clear spirit obscured becomes Jue. All Jue belongs to Jueyin. Now left thigh numbness/paralysis, alternating clarity/confusion, all Liver/Gallbladder Minister Fire and internal wind not quiet. Disease extends days, left pulse small and soggy, heat wins, fluids secretly injured. Should not purely use attacking bitter-cold. Classic states Liver is rigid organ, opposing Stomach. Softening and moistening, Yang harmony and fluid recovery can prevent epilepsy.

Fresh Rehmannia Root, Acorus Tatarinowii Rhizome, Biota Seed, Donkey-hide Gelatin, Asparagus Fern Tuber, Spirit of Poria.

Hemiplegia, Wind theory says: Evil strikes Shu points of Five Zang and Six Fu, entering gates to cause disease, then four limbs cannot rise. Yang governs left, Yin governs right. Also says: Sweating on one side causes hemiplegia. This is external evil, or Ying/Wei both deficient, evil enters via deficiency, or internal void wind moves. Physicians treating should tonify Zheng to expel evil, not expel evil neglecting Yuan Qi. Treatment method focuses on Yangming.

Astragalus Root, White Peony Root, Angelica Sinensis, Saposhnikovia Root, Teasel Root, Dioscorea Hypoglauca Rhizome, Silkworm Frass, Tangerine Peel, Tiger Bone (Synthetic/Substitute implied), Gentian Root.